Transmyocardial laser revascularization using the Holium-YAG laser for treatment of end stage coronary artery disease

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Abstract
Objective: Transmyocardial Laserrevascularization (TMLR) is a treatment for end-stage coronary artery disease, that is not eligible for surgery or PTCA. The experience with TMLR using the Holium YAG laser is presented. Methods: Transmyocardial Laserrevascularization (TMLR) was performed in 28 patients with end stage coronary artery disease, using a new Holium YAG Laser. All patients were refractory to a maximum of medical treatment. In 16 patients TMLR was used as the sole therapy with a mean of 28±4 laser created channels (group A). In 12 patients TMLR was combined with coronary artery bypass graft surgery with a mean of 17±2 channels and 1.3±0.2 grafts (group B). Preoperative and postoperative examination included angina classification, exercise test and thallium scan. Results: Postoperative demographics were as follows: (a) age 55–71 years (mean 63.9±6.5 years); (b) Canadian Cardiovascular Society Angina Scale (CCS) mean 3.3±0.5; (c) ejection fraction 35–71% (mean 54±13.7%). All patients had an peri- and postoperative course without major complications and a duration of hospitalization of 8.2±1.9 days. Minor complications were a clinically silent myocardial infarction n=1, atrial arrhythmia n=2 and pneumothorax n=2. A follow-up at 3–12 months was completed in 23 patients (82%). Only one patient died 5 months after surgery (cardiac related death). In all remaining patients CCS had improved with a mean of 1.6±0.3, P≪0.01. The exercise tolerance test (bicycle) improved in 17 patients with a mean 26.5±6.5 watt, P≪0.01. The ejection fraction did not significantly improve. The repeated thallium scan did not show an improvement of perfusion in the lasered area to a significant level. Subjective benefit from the treatment was confirmed by 21 patients. Conclusion: Based on these results it is concluded that TMLR with the Holium-YAG laser is a safe therapy for the treatment of end stage coronary artery disease. The postoperative clinical results are comparable to that achieved with the CO2-laser in terms of reducing angina symptoms and improving exercise tolerance and quality of life. However, relief of symptoms is not correlated to objective findings of cardiac function.